The psychometric properties of the Salthouse Listening Span (SLS; Salthouse & Babcock, 1991) task are relatively unknown.

Previous research has demonstrated that SLS performance is positively associated with processing speed and vocabulary (Salthouse, 2005). Further research has documented that SLS performance is useful in differentiating attention deficit/hyperactive disorder from other clinical conditions (Nikolas, Marshall, & Hoelzle, 2019). While the SLS task is purported to measure working memory, relatively little is known about how the task is related to frequently administered neuropsychological measures. Furthermore, it remains unclear whether emotional functioning may affect task performance. The current study investigates associations between frequently administered tasks and the SLS as well as the impact of anxiety and depression on SLS performance.

A battery of neuropsychological tasks and self-report measures was administered to undergraduates [N=161, 75.2% female, Mage=19 (1.06), MGPA=3.5(.35)]. Participant exclusion based on failed performance validity task, non-native English speaking, and/or task incompletion resulted in a final sample of N=131. Participants completed the SLS, a task where one answers questions about sentences read aloud to them, while simultaneously attempting to remember the final word from sentences. SLS performance was quantified two ways: (1) longest span score (SLS-LSS) and (2) total words recalled correctly (SLS-WRC). Anxiety and depression were measured via the Beck Anxiety Index (BAI) and the Beck Depression Index (BDI). Two groups were derived based on participant BAI and BDI responses: low to mild emotional distress (N=99, scores of 0-15 on BAI, BDI, or both) and moderate to severe emotional distress (N=33, scores of 16-63 on the BDI, BAI, or both). Correlations were conducted between the SLS and WAIS-IV: digit span, arithmetic, coding, and symbol search, DKEFS: verbal fluency, and WTAR. A one-way ANOVA was run to examine potential differences in performance on the SLS based on levels of emotional distress.

The SLS-LSS had negligible correlations with verbal fluency, coding, or symbol search performances (r<0.1). SLS-LSS demonstrated a small to medium positive correlation with arithmetic [r(130)=0.17, p=.06], digit span [r(130)=0.27, p=.002], and WTAR [r(130)=.27, p=.002]. SLS-WRC did not demonstrate meaningful correlations with any cognitive domain. Overall, the presence of moderate anxiety and/or moderate depression did not significantly affect performance on SLS- LSS [F(1, 130)= 1.5, p=0.22] or SLS-WRC [F(1, 132)=0.55, p=0.46].

The SLS is a promising cognitive task with little research investigating its psychometric properties. Overall, minimal correlations were observed with tasks quantifying executive functioning, verbal abilities, and processing speed. Lack of strong correlations indicate that more research should be conducted to fully understand what this task is measuring. Moreover, the SLS-WRC score did not appear to have significant correlations across domains, indicating that the SLS-LSS may be more strongly related to working memory and general intelligence. Encouragingly, emotional functioning did not appear to impact performance on this task. While the SLS appears to have some relation to IQ, more research should be conducted to determine what this task measures and what variables may affect task performance.

Neuropsychiatric/behavioral-psychological symptoms of dementia (BPSD) frequently contribute to worse prognosis of patients with neurodegenerative conditions. BPSD are commonly measured via a brief, informant-rated version of the Neuropsychiatric Inventory (NPI), the NPI-Q. Previously (see our other submission to this conference), we established optimal latent structures by comparing different factor models in the literature using confirmatory factor analyses (CFAs). However, questions remain as to why so many different models were found in the literature. One possibility is sampling differences, including different proportions of individuals across cognitive stages (e.g., mild cognitive impairment, moderate dementia) or syndromes (e.g., Alzheimer’s amnestic syndrome, Dementia with Lewy Bodies). We tested this hypothesis by subjecting candidate models to measurement invariance (MI) analyses stratified by cognitive stage and syndrome.

Individuals were included if they had completed an NPI-Q during their first visit at an Alzheimer Disease Research Center reporting to the National Alzheimer Coordinating Center (NACC). This resulted in 20,500 individuals (57% female; 80% White, 13% Black, 8% Hispanic), with a mean age of 71 (SD = 10.41) and 15 average years of education (SD = 3.43). Regarding staging, 75.9% of individuals did not meet criteria for all-cause dementia, whereas 24.1% individuals had all-cause dementia. Regarding syndromes, 35.6% had an Alzheimer’s presentation (“AD-type”) and 5.6% had either a behavioral variant frontotemporal dementia or Lewy-Body dementia presentation (“behavioral-type”). A 3-factor and 4-factor model were subject to MI across these groupings. We conducted MI analyses for equal forms, equal loadings, and equal intercepts using the lavaan R package with a diagonally weighted least squares (DWLS) estimator.

The 3-factor model demonstrated good fit among individuals experiencing (CFI = 0.965, TLI = 0.955) and not experiencing (CFI = 0.984, TLI = 0.979) dementia, as well as among AD-type (CFI = 0.983, TLI = 0.978) presentations, but had borderline poor fit for behavioral-type (CFI = 0.932, TLI = 0.912) presentations. The 4-factor model had better fit among those experiencing (CFI = 0.985, TLI = 0.977) and not experiencing (CFI = 0.995, TLI = 0.992) dementia. Additionally, the 4-factor model demonstrated good of fit for AD-type (CFI = 0.993, TLI = 0.989) and poorer fit for behavioral-type (CFI = 0.949, TLI = 0.922) syndromes. Chi-square differences suggested that equal loading and equal intercept hypotheses should be rejected for both 3- and 4-factor models, for both staging and syndromal groupings. However, relative fit indices suggested that the equal form, equal loading, and equal intercept hypotheses could be adequate for only the 4-factor model.

The variability of factor structures in the BPSD literature appears, at least partially, explained by sampling variability among cognitive stages and dementia syndromes. The best models in the literature appear to have good fit in non-demented individuals and, among those who have dementia, in those with an AD syndrome. Only Sayegh & Knight’s 4-factor model had adequate (albeit, not optimal) fit among those with all-cause dementia and, more specifically, among those with a behavioral-type dementia syndrome. These findings inform BPSD theory and practical implementation of NPI-Q subscales.

Existing research has demonstrated that neuropsychiatric/behavioral-psychological symptoms of dementia (BPSD) frequently contribute to worse prognosis in patients with neurodegenerative conditions (e.g., increased functional dependence, worse quality of life, greater caregiver burden, faster disease progression). BPSD are most commonly measured via the Neuropsychiatric Inventory (NPI), or its briefer, informant-rated questionnaire (NPI-Q). Despite the NPI-Q’s common use in research and practice, there is disarray in the literature concerning the NPI-Q’s latent structure and reliability, possibly related to differences in methods between studies. Also, hierarchical factor models have not been considered, even though such models are gaining favor in the psychopathology literature. Therefore, we aimed to compare different factor structures from the current literature using confirmatory factor analyses (CFAs) to help determine the best latent model of the NPI-Q.

This sample included 20,500 individuals (57% female; 80% White, 12% Black, 8% Hispanic), with a mean age of 71 (SD = 10.41) and 15 average years of education (SD = 3.43). Individuals were included if they had completed an NPI-Q during their first visit at one of 33 Alzheimer Disease Research Centers reporting to the National Alzheimer Coordinating Center (NACC). All CFA and reliability analyses were performed with lavaan and semTools R packages, using a diagonally weighted least squares (DWLS) estimator. Eight single-level models using full or modified versions of the NPI-Q were compared, and the top three were later tested in bifactor form.

CFAs revealed all factor models of the full NPI-Q demonstrated goodness of fit across multiple indices (SRMR = 0.039-0.052, RMSEA = 0.025-0.029, CFI = 0.973-0.983, TLI = 0.9670.977). Modified forms of the NPI-Q also demonstrated goodness of fit across multiple indices (SRMR = 0.025-0.052, RMSEA = 0.0180.031, CFI = 0.976-0.993, TLI = 0.968-0.989). Top factor models later tested in bifactor form all demonstrated consistently stronger goodness of fit regardless of whether they were a full form (SRMR = 0.023-0.035, RMSEA = 0.015-0.02, CFI = 0.992-0.995, TLI = 0.985-0.991) or a modified form (SRMR = 0.023-0.042, RMSEA = 0.015-0.024, CFI = 0.985-0.995, TLI = 0.9770.992). Siafarikas and colleagues’ (2018) 3-factor model demonstrated the best fit among the full-form models, whereas Sayegh and Knight’s (2014) 4-factor model had the best fit among all single-level models, as well as among the bifactor models.

Although all factor models had adequate goodness of fit, the Sayegh & Knight 4-factor model had the strongest fit among both single-level and bifactor models. Furthermore, all bifactor models had consistently stronger fit than single-level models, suggesting that BPSD are best theoretically explained by a hierarchical, non-nested framework of general and specific contributors to symptoms. These findings also inform consistent use of NPI-Q subscales.

Precariously housed individuals are exposed to multiple adverse factors negatively impacting neurocognitive functioning. Additionally, this population is subjected to poor life outcomes, such as impaired psychosocial functioning. Neurocognitive functioning plays an important role in psychosocial functioning and may be especially critical for precariously housed individuals who face numerous barriers in their daily lives. However, few studies have explicitly examined the cognitive determinants of functional outcomes in this population. Cognitive intraindividual variability (IIV) involves the study of within-person differences in neurocognitive functioning and has been used as marker of frontal system pathology. Increased IIV has been associated with worse cognitive performance, cognitive decline, and poorer everyday functioning. Hence, IIV may add to the predictive utility of commonly used neuropsychological measures and may serve as an emergent predictor of poor outcomes in at-risk populations. The objective of the current study was to examine IIV as a unique index of the neurocognitive contributions to functional outcomes within a large sample of precariously housed individuals. It was hypothesized that greater IIV would be associated with poorer current (i.e., baseline) and long-term (i.e., up to 12 years) psychosocial functioning.

Four hundred and thirty-seven adults were recruited from single-room occupancy hotels located in the Downtown Eastside of Vancouver, Canada (Mage = 44 years, 78% male) between November 2008 and November 2021. Baseline neurocognitive functioning was assessed at study enrolment. Scores from the Social and Occupational Functioning Assessment Scale (SOFAS), the Role Functioning Scale (RFS), the physical component score (PCS) and the mental component score (MCS) of the 36-Item Short Form Survey Instrument were obtained at participants’ baseline assessments and at their last available follow-up assessment to represent baseline and long-term psychosocial functioning, respectively. Using an established formula, an index of IIV was derived using a battery of standardized tests that broadly assessed verbal learning and memory, sustained attention, mental flexibility, and cognitive control. A series of multiple linear regressions were conducted to predict baseline and long-term social and role functioning (average across SOFAS and RFS scores), and PCS and MCS scores from IIV. In each of the models, we also included common predictors of functioning, including a global cognitive composite score, age, and years of education.

The IIV index and the global composite score did not explain a significant proportion of the variance in baseline and long-term social and role functioning (p > .05). However, IIV was a significant predictor of baseline (B = -3.84, p = .021) and long-term (B = -3.58, p = .037) PCS scores, but not MCS scores (p > .05). The global composite score did not predict baseline or long-term PCS scores.

IIV significantly predicted baseline and long-term physical functioning, but not mental functioning or social and role functioning, suggesting that IIV may be a sensitive marker for limitations in everyday functioning due to physical health problems in precariously housed individuals. Critically, the present study is the first to show that IIV may be a useful index for predicting poor long-term health-related outcomes in this population compared to traditional neuropsychological measures.

Digit Span has been a core Working Memory task, with extensive research conducted on the Forward and Backward components. The latest revision of the WAIS-IV introduced the Sequencing component, designed to increase the working memory and mental manipulation demands. However, relatively little research has been done to understand how Sequencing can be interpreted in clinical settings, as compared to Forward and Backward. The purpose of this study was to investigate how effectively individual components of the Digit Span task predict performance on four independent neuropsychological measures with high working memory demands.

Subjects included 148 adults (Age: M= 39.22, SD= 13.61; Handedness= 130 right, 10 left and 8 mixed; Males = 88) with refractory epilepsy. Two subjects had primary generalized seizures while 146 subjects had complex partial seizures (EEG Localization: 44 right temporal; 60 left temporal; 24 independent bitemporal; 1 left extratemporal; 17 indeterminant). Dependent variables included the 2.4 second ISI trial of the Paced Auditory Serial Addition Task (PASAT); the sum of correct responses on Trial 1 and List B of the California Verbal Learning Test (CVLT); the DKEFS Tower Test raw score; and completion time on Part B of the Trail Making Test. The independent variables included the individual raw scores for the Forward, Backward and Sequencing components of the WAIS-IV. Hierarchical linear regression was conducted to determine the variance accounted for by each component of the Digit Span and if that variance was redundant or unique. The four dependent variables were analyzed separately with Digits Forward, Backward and Sequencing entered in a single block.

PASAT: The overall model was significant, R2= 0.36. When examining the individual components, Sequencing was the only significant predictor (ß = 0.422, p < 0.001). CVLT: The overall model was significant, R2 = 0.203. When examining the individual components, Sequencing was the only significant predictor (ß = 0.410, p < 0.001). Tower Test: The overall model was significant, R2 = 0.176. When examining the individual components, Sequencing was the only significant predictor (ß = 0.373, p = 0.004). Trail Making: The overall model was significant R2 = 0.315. When examining the individual components both Forward (ß = -0.287, p =0.005) and Sequencing (ß= -0.364, p < 0.001) accounted for a significant amount of the variance.

The combined model for Digit Span accounted for significant amounts of variance in performance on all dependent measures, ranging from 17.6% to 36%. Sequencing accounted for substantially more variance across all examined tasks. On the PASAT, CVLT and Tower Test, the variance accounted for by the components of Digit Span appears to be redundant. However, on Trail Making, both Forward and Sequencing accounted for significant amounts of variance that appear to be independent of one another. What specific task requirement(s) of the Trail Making Test versus the other measures analyzed are accounted for by Forward span is not clear. But this suggests that the individual components of the Digit Span test may measure different things across different tasks.

As the presentation of anxiety may differ between younger and older adults, it is important to select measures that accurately capture anxiety symptoms for the intended population. The 21-item Beck Anxiety Inventory (BAI) is widely used; however, its high reliance on somatic symptoms may result in artificial inflation of anxiety ratings among older adults, particularly those with medical conditions. The 30-item Geriatric Anxiety Scale (GAS) was specifically developed for older adults and has shown strong psychometric properties in community-dwelling and long-term care samples. The reliability and validity of the GAS in a memory clinic setting is unknown. The present study aimed to compare the psychometric properties of the GAS and the BAI in a memory disorder clinic sample.

Participants included 35 older adults (age=73.3±5.0 years; edu=15.3±2.8 years; 42% female; 89% non-Hispanic white) referred for a neuropsychological evaluation in a memory disorders clinic. In addition to the GAS and BAI, the Geriatric Depression Scale (GDS) and Montreal Cognitive Assessment (MoCA) were included. Cutoffs for clinically significant anxiety were based on published data for each measure. A dichotomous anxiety rating (yes/no) was created to examine inter-measure agreement; minimal anxiety was classified as “no” and mild, moderate and severe anxiety were classified as “yes.” Internal scale reliability was examined using Cronbach’s alpha. Convergent and discriminant validity were examined using Spearman rank correlation coefficients. Frequency distributions determined the proportion of yes/no anxiety ratings, and a McNemar test compared the proportion of anxiety classifications between the two measures.

Both measures had excellent internal consistency (BAI: a=.88; GAS: a=.94). The BAI and GAS were highly correlated with each other (r=.79, p<.001) and positively correlated with a depression measure (BAI-GDS: r=.51, p=.002; GAS-GDS: r=.53, p=.001). Discriminant validity was supported by lower correlations between the anxiety measures and cognition (BAI-MoCA: r=.38, p=.061; GAS-MoCA: r=.34, p=.098). The BAI classified 14 participants as having anxiety (40%) and 21 participants as not having anxiety (60%), whereas the GAS classified 21 participants as having anxiety (60%) and 14 participants as not having anxiety (40%). The proportion of anxiety classifications were significantly different between the two measures (p =.016). For 28 participants (80%), there was agreement between the anxiety ratings. Seven participants (20%) were classified as having anxiety by the GAS, but not by the BAI; GAS items related to worry about being judged or embarrassed may contribute to discrepancies, as they were frequently endorsed by these participants and are unique to the GAS.

Results support that both anxiety measures have adequate psychometric properties in a clinical sample of older adult patients with memory concerns. It was expected that the BAI would result in higher classification of anxiety due to reliance on somatic symptoms; however, the GAS rated more participants as having anxiety. The GAS may be more sensitive to detecting anxiety in our sample, but formal anxiety diagnoses were not available in the current dataset. Future research should examine the diagnostic accuracy of the GAS in this population. Overall, preliminary results support consideration of the GAS in memory disorder evaluations.

Previous research has found that measures of premorbid intellectual functioning may be predictive of performance on memory tasks among older adults (Duff, 2010). Intellectual functioning itself is correlated with education. The purpose of this study was to investigate the incremental validity of a measure of premorbid intellectual functioning over education levels to predict performance on the Virtual Environment Grocery Store (VEGS), which involves a simulated shopping experience assessing learning, memory, and executive functioning.

Older adults (N = 118, 60.2% female, age 60-90, M = 73.51, SD = 7.46) completed the Wechsler Test of Adult Reading and the VEGS.

WTAR and education level explained 9.4% of the variance in VEGS long delay free recall, F = 5.97, p = 0.003). WTAR was a significant predictor (ß = 0.25, p = 0.006), while level of education was not.

These results suggest that crystalized intelligence may benefit recall on a virtual reality shopping task.

Research shows that highly educated individuals have at least 20 graphomotor features associated with clock drawing with hands set for '10 after 11' (Davoudi et al., 2021). Research has yet to understand clock drawing features in individuals with fewer years of education. In the current study, we compared older adults with < 8 years of education to those with > 9 years of education on number and pattern of graphomotor feature relationships in the clock drawing command condition.

Participants age 65+ from the University of Florida (UF) and UF Health (N= 10,491) completed both command and copy conditions of the digital Clock Drawing Test (dCDT) as a part of a federally-funded investigation. Participants were categorized into two education groups: < 8 years of education (n= 304) and > 9 years of education (n= 10,187). Propensity score matching was then used to match participants from each subgroup (n= 266 for each subgroup) on the following demographic characteristics: age, sex, race, and ethnicity (n= 532, age= 74.99±6.21, education= 10.41±4.45, female= 42.7%, non-white= 32.0%). Network models were derived using Bayesian Structure Learning (BSL) with the hill-climbing algorithm to obtain optimal directed acyclic graphs (DAGs) from all possible solutions in each subgroup for the dCDT command condition.

Both education groups retained 13 of 91 possible edges (14.29%). For the < 8 years of education group (education= 6.65±1.74, ASA= 3.08±0.35), the network included 3 clock face (CF), 7 digit, and 3 hour hand (HH) and minute hand (MH) independent, or “parent,” features connected to the retained edges (BIC= -7395.24). In contrast, the > 9 years of education group (education= 14.17±2.88, ASA= 2.90±0.46) network retained 1 CF, 6 digit, 5 HH and MH, and 1 additional parent features representing the total number of pen strokes (BIC= -6689.92). Both groups showed that greater distance from the HH to the center of the clock also had greater distance from the MH to the center of the clock [ßz(< 8 years)= 0.73, ßz(> 9 years)= 0.76]. Groups were similar in the size of the digit height relative to the distance of the digits to the CF [ßz(< 8 years)= 0.27, ßz(> 9 years)= 0.56]. Larger HH angle was associated with larger MH angle across groups [ßz(< 8 years)= 0.28, ßz(> 9 years)= 0.23].

Education groups differed in the ratio of dCDT parent feature types. Specifically, copy clock production in older adults with < 8 years of education relied more heavily on CF parent features. In contrast, older adults with > 9 years of education relied more heavily on HH and MH parent features. Individuals with < 8 years of education may more infrequently present the concept of time in the clock drawing command condition. This study highlights the importance of considering education level in interpreting dCDT scores and features.

Research shows that highly educated individuals have at least 20 graphomotor features associated with clock drawing with hands set for '10 after 11' (Davoudi et al., 2021). Research has yet to understand clock drawing features in individuals with fewer years of education. In the current study, we compared older adults with < 8 years of education to those with > 9 years of education on number and pattern of graphomotor feature relationships in the clock drawing copy condition.

Participants age 65+ from the University of Florida (UF) and UF Health (N= 10,491) completed command and copy digital Clock Drawing Tests (dCDT) as a part of a federally-funded investigation. Participants were categorized into two groups: < 8 years of education (n= 304) and > 9 years of education (n= 10,187). Propensity score matching was used to match participants from each subgroup (n= 266 for each subgroup) on the following: age, sex, race, and ethnicity (n= 532, age= 74.99±6.21, education= 10.41±4.45, female= 42.7%, non-white= 32.0%). Network models were derived using Bayesian Structure Learning (BSL) with the hill-climbing algorithm to obtain optimal directed acyclic graphs (DAGs) from all possible solutions in each subgroup for the dCDT copy condition.

The < 8 years of education group (education= 6.65±1.74, ASA= 3.08±0.35), retained 12 of 91 possible edges (13.19%, BIC= -7775.50). The network retained 2 clock face (CF), 5 digit, and 5 hour hand (HH) and minute hand (MH) independent, or “parent,” features connected to the retained edges. In contrast, the > 9 years of education group (education= 14.17±2.88, ASA= 2.90±0.46) network retained 15 of 91 possible edges (16.48%, BIC= -8261.484). The network retained 2 CF, 6 digit, 4 HH and MH, and an additional 3 total stroke parent features. Both groups showed that greater distance from the HH to the clock center also had greater distance from the MH to the clock center (ßz= 0.73, both). Groups were similar in digit width size relative to digit height [ßz(< 8 years)= 0.72, ßz(> 9 years)= 0.74]. Digit height size related to CF area [ßz(< 8 years)= 0.44, ßz(> 9 years)= 0.62] and CF area related to the digit distance to the CF across groups [ßz(< 8 years)= 0.39, ßz(> 9 years)= 0.46]. Greater distance from the MH to the clock center was associated with smaller MH angle [ßz(< 8 years)= -0.35, ßz(> 9 years)= -0.31], whereas greater digit misplacement was associated with larger MH angle across groups [ßz(< 8 years)= 0.14, ßz(> 9 years)= 0.29].

Education groups differed in the ratio of dCDT parent feature types. Specifically, copy clock production in older adults with < 8 years of education relied more evenly across CF, digit, and MH and HH parent features. In contrast, those with > 9 years of education differed in the additional reliance on total stroke parent features. Individuals with < 8 years of education may more heavily rely upon visual referencing when copying a clock. This study highlights the importance of considering education level in interpreting dCDT scores and features.

The COVID-19 pandemic increased utilization of remote assessment to allow clinicians and researchers to continue valuable work while maintaining quarantine guidelines. With guidelines relaxing, researchers have returned to in-person assessment. Information is needed regarding the effect of remote assessments on test-retest reliability. COGNET, a longitudinal study of cognition in participants with essential tremor, transitioned from in-person to remote assessments during the pandemic, and has now returned to in-person assessment. The current study investigates the extent to which remote assessment affected test-retest reliability across a range of neuropsychological assessments administered in COGNET.

Participants included 27 older adults enrolled in COGNET (mean age=75.0 (9.1), education=16.2 (2.6), 67% female, and 100% white). Memory tests included: California Verbal Learning Test II, Logical Memory subtest of the Wechsler Memory Scales - Revised, and Verbal Paired? Associates. Executive function tests included: Digit Span Backwards and the Delis-Kaplan Executive Function System subtests of Verbal Fluency, Sorting, and Color-Word. Attention tests included Oral Symbol Digit Modalities Test and Digit Span Forward. Language was assessed with the Boston Naming Test. Intraclass correlation coefficients (ICCs) were calculated to examine test-retest reliability of InPerson to In-Person visits (P-P), and combination visits (e.g., In-Person to Remote (PR), and Remote to In-Person (R-P)). Following Koo & Li (2016), ICCs were interpreted as: >.90 excellent, .75-.90 good, .50-.74 moderate, and <.50 poor reliability. The Feldt approach was used to compare ICCs from P-P visits against ICCs calculated for combination visits (P-R or R-P), with the test statistic compared to an F distribution.

ICCs for person-to-person assessment ranged from .51 to .89. Memory test ICCs ranged from moderate to good (.51 to .80). Executive function test ICCs ranged from moderate to good (.55 to .89). The attention domain had moderate ICCs (.67 - .68). Language ICC was moderate (.70). ICCs for person-to-remote assessment ranged from .42 to .89. Memory tests ranged from moderate to good ICCs (.59 to .83). Executive function tests ranged from poor to good ICCs (.42 to .89). Attention ICCs were moderate to good (.55 to .79). The Language ICC was moderate (.72). ICCs for remote-to-person ranged from .48 to 86. Memory ICCs ranged from moderate to good (.59 to .86). Executive function ICCs ranged from poor to good (.48 to .83). Attention ICCs were moderate to good (.56 to .79). The Language ICC was good (.78). The only test for which an ICC from a combination visit was significantly lower than a person to person visit was Digit Span Backwards.

Test-retest reliability was moderate or better for all P-P assessments, consistent with the known psychometrics of these tests. Only one test of executive function showed lower reliability when remote assessment was introduced. From a broad standpoint, current results suggest that remote administration of neuropsychological tests can be used as a reliable substitute for in-person assessment for many measures, and suggest that caution be used when interpreting any change in Digit Span Backwards across person and remote assessments.

The Montreal Cognitive Assessment (MOCA) is widely used as a mental status screening test to detect cognitive impairment in adults over 55 years of age. Performance on this test ranges from 0 to 30. One point is given to individuals with 12 or lower years of education. This accommodation is based on the fact that low education may be a risk factor for dementia (Milani et al., 2018). However, studies suggest the one-point adjustment may not be sufficient to address the impact of low education on test performance (Malek-Ahmadi et al., 2015). The aim of this study is to compare the effects of educational achievement versus baseline verbal abilities on MOCA performance.

Fifty patients (25 male; mean age=72.78, SD = 8.11; mean education=16.18, SD = 2.73) with cognitive concerns were referred to Massachusetts General Brigham. All underwent neuropsychological evaluation, including screening with the MOCA. Total MOCA scores were calculated. In this patient group, the MOCA scores ranged from 10 to 29 (mean=22, SD=5.129). Measures of literacy (Wechsler Test of Adult Reading or Test of Premorbid Functioning) were used to estimate baseline verbal abilities. Educational achievement was based on self-reported years of education.

Correlational analyses included the Total MOCA scores, measures of literacy, and years of education. Performance on the MOCA significantly correlated with measures of literacy, r(43)=.578, p< .001, and a stepwise regression analysis revealed that literacy predicted performance on the MOCA, R2=.041, F(3,139)= 9.172, p<.001. Years of education correlated with measures of literacy, r(44)=.494, p< .001, but not with performance on the MOCA.

Findings suggest that education-adjusted scoring on the MOCA may not be sufficient to “level the playing field” in terms of MOCA performance. Years of education had less of an effect on the Total MOCA scores than did baseline verbal abilities. It may be the case that literacy has a more robust effect on MOCA performance due to the inherent verbal nature of the MOCA. Data from this study highlight the importance of considering a patient’s baseline verbal abilities in the interpretation of their MOCA performance.

Appropriate adjustments to normative data for neuropsychological (NP) tests are imperative for their equitable use in brain health practices. Age and education are known to be strong predictors of test performance. In settings where validated tests are not available, common practice has been to adapt and apply them in similar fashion as settings where they were developed. However, demographic adjustments cannot be assumed de facto to be universal in their strength and domain associations. For example, South Africa (SA) and Zimbabwe are neighboring countries with some similarities in their demographic makeup, but with vastly different sociopolitical trajectories- Zimbabwe was colonially occupied until 1980 and SA was oppressed under Apartheid until 1994- which have impacted access to and quality of education by severely limiting educational opportunities for native citizens. The present study explored whether the direction and strength of relationships between age and education on NP test performance were similar or not between SA and Zimbabwe adults living with and without HIV.

Data was extracted from two IRB-approved studies in SA and Zimbabwe with similar inclusion and exclusion criteria. The SA sample (n=214) was comprised of 56% females, 48% HIV-positive adults, mean age of 34 years, and a nine-year range in education (3-14 years). The Zimbabwe sample (n=212) was comprised of 68% females, 67% HIV-positive adults, mean age of 36 years, and a thirteen-year range in education (7-20 years). Participants completed NeuroScreen, a tablet-based battery of 12 brief NP tests adapted for indigenous SA and Zimbabwe languages. The two study samples were analyzed separately. Zero order correlations between each of the tests and age and gender were conducted to determine the influence of the demographic variables. Relationships with moderate correlations (r>0.3) in both samples were further analyzed using univariate ANOVA to examine the main effects and interactions of age and education

Overall, there was a similar pattern of results across samples, with nine tests showing no-to-low associative relationships with age and education respectively. Moderate, significant relationships were found between age, education and three tests of processing speed (Visual Discrimination A, Visual discrimination B, and Number Speed) in both samples. Age and education had different effects on Visual discrimination A across samples with a significant main effect for age but not education in SA [F(40,83)=3.060, p<0.01], whilst Zimbabwe had a significant main effect for education but not age [F(10,87)=4.541, p<0.01]. Visual Discrimination B and Number Speed showed significant main effects for both variables in both samples. However, there was a significant interaction for both tests in Zimbabwe only.

The current study is novel in its exploration of country-specific relationships between NP test performance and demographic factors in settings where assessment science is emergent. Results demonstrate the presence of differential relationships between demographic variables on test performance which raises questions about the source of these differences. One important potential source is the socio-cultural context of each country and the intersection of demographic factors in these contexts. Further research is required to explore these considerations.

Semantic fluency measures comprise a differing number of trials depending on the test battery and/or normative data used. Using semantic fluency trials from the Delis Kaplan Executive Function System (D-KEFS; Animals and Boys’ names), we sought to examine whether: 1) there was incremental benefit of multiple trials in associations with aggregated temporal cortical thickness and 2) patterns of neuroanatomical associations with specific temporal lobe structures differed between Animals and Boys’ names trials.

Archival records of adults who completed a neuropsychological evaluation which included the semantic fluency measures of interest and had undergone structural MRI were identified (n=243, Mage=72.35 years, SDage=6.74, Female=46.9%). Cortical thickness values were obtained using FreeSurfer and averaged across sub-regions, separately for the left and right temporal lobe, per recommendations from the FreeSurfer group. Multiple linear regression models were fit to examine separate and incremental contribution of both Animals and Boys’ names, on temporal lobe thickness, including age, sex, and education in the models. Zero order correlations with each of the temporal cortical thickness areas (inferior, middle, and superior temporal; banks of the superior temporal sulcus, fusiform, transverse temporal, entorhinal, temporal pole, and parahippocampal cortices) were also computed to identify more focal neuroanatomical correlates.

Animals and Boys’ names trials individually accounted for a significant proportion of variance when predicting temporal cortical thickness over and above demographics, but Animals was a considerably stronger predictor for left temporal cortical thickness (Left: Animals AR2 =.127*, Boys’ names AR2 = .067*; Right: Animals AR2 =.074*, Boys’ names AR2 = .065*). The variance accounted for by Boys’ names incrementally over Animals was not significant (AR2 = .004 for left and .015 for right hemispheres, respectively). Similarly, though the composite Category fluency index accounted for a significant proportion of the variance independently, it did not add incrementally over and above Animals alone when predicting cortical thickness in either hemisphere. When examining simple correlations with specific temporal cortices, Animals consistently had correlations of a greater magnitude than Boys’ names within the left hemisphere (Animals r>.3 for superior, middle, inferior, and fusiform gyri; Boys’ names r< .3 for all cortical thickness regions). Greater variability was noted for associations with right temporal thickness but Animals continued to show associations of a greater magnitude of associations than Boys’ names for several sub-regions. * denotes significance at p < .01.

The additional Boys’ names trial does not confer significant benefit over Animals alone, when predicting cortical thickness in either temporal lobe. Additionally, overall category fluency provided little incremental utility over and above the Animals trial alone in predicting temporal thickness. Psychometrically, it is expected that composites derived from multiple trials are more robust. However, this study demonstrates that it is important to examine whether the administration of additional trials is truly beneficial, particularly in a climate where brevity of neuropsychological assessment is critically desired. Further, psychometric tests have historically been validated against other neuropsychological measures, but it is critical we also validate measures against neuroanatomical correlates.

Ensuring test-taking validity is a crucial part of any neuropsychological evaluation. While all batteries ought to include well established test-taking validity measures regardless, it can still be helpful to be aware of an increased chance of poor performance validity prior to initiating testing. Studies repeatedly demonstrate that it is very difficult to predict which patient, particularly those without any clear incentive for poor test performance, will have invalid test performances based purely on subjective clinical judgment. Therefore, there is a need for an objective predictor of poor test taking validity. This study examines if a high endorsement of cognitive symptoms can indicate likely failure on test-taking validity measures.

All patients at an outpatient neurological clinic completed an intake background form prior to testing. On this form, patients were asked to endorse in which, if any, of nine cognitive areas they may be experiencing difficulty (memory, attention/concentration, word finding, etc.). Patients who endorsed at least eight out of the nine clinical symptoms on the intake form were included in the current study (N=7; age range 36-43 years). All patients were clinically referred for a comprehensive neuropsychological evaluation with a variety of conditions (e.g., stroke, memory concerns, and post-COVID-19 syndrome). Importantly, none of these patients were referred within a forensic context, and therefore, they did not have any clear external motivation or secondary gain. In addition to a battery of individual neuropsychological measures, each patient was administered performance validity tests (Test of Memory Malingering, Reliable Digits, and CVLT-3 Forced Choice).

In this sample, 57% of patients who endorsed all - or nearly all - cognitive symptoms on an intake form failed test-taking validity measures. Patients who failed validity measures did not meet passing criteria on two or more embedded or independent performance validity tests. This signifies a much higher rate than the typically observed base rates (∼15%) of test-taking invalidity across non-forensic clinical settings.

Preliminary findings suggest that those who indicate having cognitive problems in all (or nearly all) listed domains fail validity measures at a higher than expected rate, supporting the use of responses on a background from to indicate likely poor performance validity. Identification of high rates of symptomatic complaints, particularly symptoms that may extend beyond the initial referral question, should prompt practitioners to keenly evaluate performance validity and consider the results within the context of the patient’s presentation.

To investigate the latent factor structure and construct validity of the Verbal Series Attention Test (VSAT) across clinical patient populations.

Participants included a consecutive series of clinical patients presenting with a primary memory complaint. Each patient underwent a comprehensive neuropsychological assessment and provided informed consent to allow their clinical data to be used for research. Groups formed included 1) No Neurocognitive Disorder [NoND, N=262, mean age=68.8, mean education=16.2, mean MMSE=28.3], 2) Mild Neurocognitive Disorder [MildND, N=337, mean age=72.3, mean education=15.4, mean MMSE=28.7], and 3)

Major Neurocognitive Disorder [MajorND, N=524, mean age=76.5, mean education=14.5, mean MMSE=19.0] with etiologies including suspected Alzheimer’s disease and/or vascular pathology. Latent factors were investigated using exploratory factor analysis (EFA).

EFA was conducted using SAS 9.4 software and the promax (oblique) rotation to reveal the latent factors of the eight timed items of the VSAT in each of the three clinical groups. The structure was essentially identical in all three groups with two primary factors consistently emerging identified as 1-Complex Attention and 2-Simple Attention. Each factor had four items loading with a correlation range of > 0.37 x < 0.92. The internal consistency (Cronbach’s alpha) for the VSAT total score in each group was excellent (NoND a=0.83, MildND a=0.81, and MajorND a=0.84). To investigate construct validity, the VSAT items were entered into factor analysis with measures of attention and executive function (i.e., Digit Span [forward, backward, sequence], Trail Making Test A & B, semantic fluency (animals), Controlled Oral Word Association Test [COWAT, FAS]). All three patient groups were combined (N=950) given the VSAT’s consistent factor structure. Using the same EFA procedure as before, two main factors emerged with the VSAT Complex Attention variables loading on a general complex attention/working memory factor including Trails B, semantic fluency, and Digit Span subtests. The VSAT Simple Attention items loaded on a general attention factor with the VSAT Simple Attention variables and Trails A. COWAT did not load significantly on either factor.

The latent factor structure of the VSAT was consistent across patient populations with excellent internal consistency in each clinical group. The Complex and Simple Attention factors of the VSAT loaded on factors with similar variables identifying the anticipated latent factor structure demonstrating the construct validity of the VSAT across a wide spectrum of cognitive impairment in patients with primary memory complaints ranging from NoND to MajorND. This supports the use of the VSAT in patients across neurocognitive severity. Future studies will further explore additional psychometric properties of this instrument.

Assessment of response validity is essential to neuropsychological assessment. Although informant report of examinee functioning has previously been associated with examinee-generated performance and cognitive symptom invalidity (PVT; SVT-C), empirically-derived guidelines for interpreting informantreport validity are lacking. This study sought to assess the classification accuracy of a widely used informant-report measure, the Dementia Severity Rating Scale (DSRS), for discriminating examinee-generated PVT and SVT-C.

Data were collected from 145 examinee-informant dyads who completed neuropsychological batteries as part of a routine workup in an epilepsy monitoring unit. PVT status was determined by below-threshold performances on >2 indicators (Test of Memory Malingering, Wechsler Digit Span Age Corrected Scaled Score, Word Memory Test). SVT-C status was determined by above-threshold responses on both the Minnesota Multiphasic Personality Inventory-2-Restructured Form Response Bias Scale (MMPI-2-RF RBS) and Structured Inventory of Malingered Symptomatology Amnestic Disorders subscale (SIMS-AM). After assessing demographic and relational covariance via t-test and chi square analyses, receiver operator characteristic curves were derived to assess the classification accuracy of the DSRS for discriminating examinee PVT and SVT-C status.

DSRS total score demonstrated acceptable accuracy in classifying PVT status (AUC = .77), with cut scores of >21 and >15 yielding .93-.82 specificity and .44-.63 sensitivity. The DSRS also classified SVT-C status with acceptable accuracy (AUC = .71), with the aforementioned cut scores exhibiting .90-.78 specificity and .50-.64 sensitivity. The DSRS also classified SVT-C status using only one indicator (i.e., MMPI-2-RF RBS or SIMS-AM) with acceptable accuracy (AUC = .71-.72), with the aforementioned cut scores exhibiting .92 specificity and .37-.42 sensitivity.

The DSRS can be used to classify examinee-generated PVT and SVT-C on an epilepsy monitoring unit. Results provide empirically-derived psychometric guidelines for interpreting informant-report response validity that are clinically useful and lay the groundwork for future investigations of informant-report response validity.

The prevalence of dementia is higher among minoritized Hispanic/Latino populations in the U.S. Development of linguistically relevant and validated cognitive assessments are urgently needed to adequately address the care needs of this at-risk group. List learning tasks are widely used to evaluate verbal episodic memory and are consistently shown to be sensitive to memory deficits across various

neurologic etiologies. The aim of this study was to validate a Spanish list learning task developed as a linguistically appropriate measure of memory in a diverse sample of Spanish speaking Bay Area older adults who identify as Hispanic/Latino.

Cognitive scores were assessed in 72 Spanish-speaking older adults living in the Bay Area, California, originally from different countries across South and Central America [(n=29 with CDR scores of 0; n=31 with CDRs of 0.5; and n=12 with CDR of 1), aged 54-96, 30% male)], who completed the Spanish list learning task and a brief neuropsychological battery. The list learning task contains 9 words, 3 words from 3 different semantic categories. Category exemplars were excluded. Administration includes three immediate recall trials, a 30-second delay free recall, 10-minute delay free and cued recall, and yes/no recognition. In this initial validation study, we selected the 10-minute delay recall trial as our primary variable and looked at several indices of construct validity. We hypothesized delayed free recall would: 1) correlate highly with other episodic memory tasks, and minimally with non-memory tests (controlling for CDR sum of boxes), and 2) show step-wise declines as total CDR increased from 0 to 1 (controlling for age, sex, and education).

Delayed recall scores of 30-seconds and 10-minutes showed step-wise declines as CDR scores increased (CDR 0 vs. 1, p<0.001 and CDR 0.5 vs. 1, p=0.001). There were no differences in delayed recall between CDR 0 vs. CDR 0.5 (p>0.05). 10-minute delay showed medium-to-large correlations with UDS Craft Story Delayed Recall (partial r =0.45, p<0.001) and Benson Complex Figure Recall (partial r=0.63, p<0.001). Nonsignificant, weaker associations were observed with measures of executive (F Word Verbal Fluency partial r=0.10, Digit Span Forward partial r=0.12), and language (Animal Fluency partial r=0.18) function.

Although there is heterogeneity within Hispanic/Latino populations in the U.S., findings begin to support ecological and construct validity of the Spanish list learning task as a measure of verbal memory in older Spanish-speaking adults in the Bay Area. Supporting ecological validity, delayed recall scores significantly differentiated functionally impaired (CDR=1) from functionally mild or unimpaired older adults (CDR=0 or 0.5), though evidenced less sensitivity differentiating unimpaired from mild stages of illness. The Spanish list learning task evidenced strong construct validity as a measure of episodic memory, including strong correlations with other validated memory tasks, and non-significant correlations with non-memory tasks. Larger studies should account for diversity of Spanish speakers in the U.S to see how region of origin, education, and differences between first- and second-generation Spanish speakers influences performance on the task. Future work incorporating imaging markers of brain structure may help further validate the Spanish list learning task as an appropriate measure of memory.

While there exist numerous validated neuropsychological tests and batteries to measure cognitive and behavioral capacities, the vast majority of these are time intensive and difficult to administer and score outside of the clinic. Moreover, many existing assessments may have limited ecological validity in some contexts (e.g., military operations). Therefore, we have been developing a novel approach to administering neuropsychological assessment using a virtual reality (VR) “game” that will collect simultaneously acquired multidimensional data that is synthesized by machine learning algorithms to identify neurocognitive strengths and weaknesses in a fraction of the time of typical assessment approaches. For our initial pilot project, we developed a preliminary VR task that involved a brief game-like military “shoot/no-shoot” task that collected data on hits, false alarms, discriminability, and response times under a context-dependent rule set. This prototype task will eventually be expanded to include a significantly more complex set of tasks with greater cognitive demands, sensor feeds, and response variables that could be modified to fit many other contexts. The objective of this project was to construct a rudimentary pilot version and demonstrate whether it could predict outcomes on standard neuropsychological assessments.

To demonstrate proof-of-concept, we collected data from 20 healthy participants from the general population (11 male; age=24.8, SD=7.8) with high average intelligence (IQ = 112, SD=10.7). All participants completed the Wechsler Abbreviated Scale of Intelligence-II (WASI-II), and several neuropsychological tests including the ImPACT, the Attention and Executive Function modules of the Neuropsychological Assessment Battery (NAB), and the VR task. Initially, we used a prior dataset from 359 participants (n=191 mild traumatic brain injury; n=120healthy control; n=48 sleep deprived) to serve as a training sample for machine learning models. Based on these outcomes, we applied machine learning, as well as standard multiple regression approaches to predict neuropsychological outcomes in the 20 test participants.

In this limited study, the machine learning approach did not converge on a meaningful prediction due to the instability of the small sample. However, standard multiple linear regression using stepwise entry/deletion of the VR task variables significantly predicted neuropsychological performance. The VR task predicted WASI-II vocabulary (R=.457, p=.043), NAB Attention Index (R=.787, p=.001), and NAB Executive Function Index (R=.715, p=.002). Interestingly, these performances were generally as good or better than the predictions resulting from the ImPACT, a commercially available neuropsychological test battery, which correlated with WASI-II vocabulary (R=.557, p=.011), NAB Attention Index (R=.574, p=.008), and NAB Executive Function Index (R=.619, p=.004).

Our pilot VR task was able to predict performances on standard neuropsychological assessment measures at a level comparable to that of a commercially available computerized assessment battery, providing preliminary evidence of concurrent validity. Ongoing work is expanding this rudimentary task into one involving greater complexity and nuance. As multivariate data integration models are incorporated into the tasks and extraction features, future work will collect data on much larger samples of individuals to develop and refine the machine learning models. With additional work this approach may provide an important advance in neuropsychological assessment methods.

Widespread musculoskeletal pain disorders like fibromyalgia are often accompanied by varying levels of cognitive dysfunction. Fibromyalgia research suggests that around the time of diagnosis, typically 30-50 years of age, many patients are already showing cognitive difficulties on various neuropsychological assessments. It is unknown, however, how older adults with fibromyalgia perform on rapid cognitive screeners in clinical settings. The present study compared older adults with and without fibromyalgia on a digitized version of a classic neuropsychological screener, the clock drawing test.

Participants aged 65+ were recruited as part of a larger IRB-approved and federally funded investigation within the preoperative surgical center at the University of Florida (UF) and UF Health. Participant data were obtained with Health Insurance Portability and Accountability Act (HIPAA) waiver and honest broker medical extraction from January 2018 to December 2019 (N=14,807). Based on medical record diagnostic code, participants were categorized into fibromyalgia or non-fibromyalgia groups, then propensity score matched based on age, ethnicity, race, sex, and years of education. The final sample contained 718 older adults (mean age= 71.3±4.89, education years= 13.7±2.62, female= 98.1%, white= 87.9%) (n=359 in each group). All participants completed the command and copy condition of the digital Clock Drawing Test (dCDT). Variables of interest for both conditions included: total completion time (TCT), pre-first hand latency (PFHL), clock face area (CFA), and digit misplacement. These variables were chosen to represent two latency and two graphomotor variables. A natural log transformation was applied to all dCDT variables to achieve normality of the distribution.

We confirmed that there was no significant group difference in age, ethnicity, race, sex, and years of education following the propensity match. Fibromyalgia patients had higher comorbidity scores on American Society of Anesthesiologists Classification (ASA) (p= 0.003). Analysis of variance (ANOVA) showed a significant group difference in TCT for both command [F(1,637)= 5.13, p= 0.024, d=0.178] and copy conditions [F(1,466)= 4.03, p= 0.045, d=0.179j. Controlling for ASA, a repeated measures analysis of covariance (ANCOVA) showed that groups still differed in TCT in the command condition [F(1,630)= 4.21, p= 0.041, n2= 0.007; Fibromyalgia > Non-Fibromyalgia], but not in the copy condition.

In our sample, older adults with fibromyalgia showed slower TCT to command by approximately three seconds compared to non-fibromyalgia peers. Since TCT to command taps into multiple domains of cognitive functioning, our results are consistent with previous work demonstrating poorer performance across many cognitive domains in fibromyalgia. Future research should continue investigating digital cognitive assessments to identify older adults with fibromyalgia who may be at higher risk for cognitive change. Data acquired through NIH R01 AG055337.

Deficits in visual-motor coordination and/or fine motor dexterity are often present in pediatric neurological and neurodevelopmental conditions and may adversely affect performance on tests with motor demands. This consideration is relevant when interpreting discrepant scores across Wechsler Intelligence Scale for Children, Fifth Edition (WISC-V) Processing Speed Index (PSI) subtests, specifically Symbol Search and the more motorically demanding Coding. Although test developers maintain that motor ability is unlikely to significantly impact Coding performances, clinicians often consider whether uneven WISC-V PSI subtest scores (Coding<Symbol Search) may in part be attributed to motor-related difficulties, when indicated. This has important clinical implications, as WISC-V Coding may then be omitted or substituted when calculating FSIQ. Thus, the present study aims to evaluate the role of motor task deficits in uneven PSI subtest scores in a sample of clinic-referred youth.

Participants were 238 children and adolescents (MAge=10.62 years; 65.5% male; 60.5% white) referred for neuropsychological assessment. All participants completed the Coding and Symbol Search subtests of the WISC-V and at least one of two motor tasks: the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI) and the Grooved Pegboard (GP). To evaluate patterns of functioning, we determined the frequencies of patients who demonstrated uneven PSI subtest performances (defined in this study as a Coding scaled score [ss] at least 3-points lower than that of Symbol Search) and/or normative weaknesses (i.e., Standard Score [SS] below 80, per recommendations from the American Academy of Clinical Neuropsychology) on motor tasks. A chi-square test of independence was used to evaluate associations between uneven PSI performance and the presence/absence of motor weaknesses. Among those with uneven PSI performance, a one-way ANOVA was used to examine whether PSI subtest difference scores varied as a function of motor performance group (No Weakness=0, VMI Weakness Only=1, GP Weakness Only=2, Weaknesses on Both=3).

Of the 238 participants, 28 (11.0%) displayed normative weaknesses on the VMI only, 43 (16.9%) displayed weaknesses on the dominant-GP only, and 18 (7.1%) displayed weaknesses on both tasks. On the WISC-V, 56 participants (23.5%) exhibited uneven PSI subtest performance (Coding<Symbol Search), with 21 (37.5%) of those participants displaying at least one normative motor weakness. Chi-square analyses indicated no significant association between the presence/absence of motor skill weakness and uneven PSI subtest performance, (X2 (3) = 5.79, p = .122). Among those with uneven PSI performance, Coding/Symbol Search difference scores were not significantly associated with motor performance group (F(3,55) = 1.26, p = .297).

These findings suggest that while patients with uneven WISC-V Coding and Symbol Search scores may also display motor task deficits, these deficits are not significantly associated with uneven performances overall. Additionally, of the participants with uneven PSI subtest scores, the majority did not exhibit normative weaknesses on motor tasks. Therefore, clinicians may be overcorrecting for a motoric cause of uneven performance and underappreciating the potential unevenness a child demonstrates in processing speed. Future studies should evaluate the role of other neurocognitive factors, such as working memory, in this score discrepancy pattern.